Tunica-sparing ossified Peyronie’s plaque excision

Authors


Michael L. Eisenberg, Department of Urology, University of California San Francisco, 400 Parnassus Ave, UC Clinics, A-631, San Francisco, California 94143-0738, USA. e-mail: michael.eisenberg@gmail.com

Abstract

Study Type – Diagnostic (non-consecutive series) Level of Evidence 3b

What’s known on the subject? and What does the study add?

Peyronie’s disease with heterotopic, ossified plaques require surgical removal. While conventional tunical excision techniques risk erectile and sensory compromise, we describe a tunical-sparing technique which maintains potency with durable results.

OBJECTIVE

Ossified Peyronie’s plaques may require surgical excision because of the palpable problems and penile curvature that result. As tunical excision can result in impotence and decrease penile sensation, we describe a novel method of tunical preserving excision of such lesions.

PATIENTS AND METHODS

We evaluated 12 men with dorsal penile curvature between 10° and 90°. Penile plaque size ranged from 1 to 5 cm. 80% had painful erections. An artificial erection was induced with intracavernous injection of papaverine to assess penile deformity. Via a circumcising or ventral incision, plication sutures were placed to correct penile curvature. A lateral longitudinal corporotomy was made and the calcified/ossified portion was dissected free from the tunica albuginea/plaque of the corpora cavernosa. Watertight tunical closure was then performed.

RESULTS

Postoperatively, 80% of men reported erections always adequate for intercourse and normal sensation with a mean follow-up of 7 months (range 2.1–14.5 months). All patients required simultaneous penile plication to ensure a straight phallus. Pathologic evaluation of plaque specimens all showed bone fragments.

CONCLUSION

Tunica-sparing excision of the ossified/calcified portion of Peyronie’s plaques shows a durable benefit for large, ossified lesions and maintains potency and penile sensation.

Ancillary